FOXP3(+) regulatory and TIA-1(+) cytotoxic T lymphocytes in HIV-associated Hodgkin lymphoma.

Human immunodeficiency virus (HIV) infects CD4(+) lymphocytes, leading to a development of malignant lymphomas, such as HIV-associated Hodgkin Lymphoma (HIV-HL). This study aimed to assess the differences in cellular composition of the inflammatory reactive background of HIV-HLs. We examined infiltrating T lymphocytes, specifically regulatory T cells, cytotoxic cells, Epstein-Barr virus (EBV) related antigens and HIV-receptor CCR5. In all HIV-HL cases, Hodgkin and Reed-Sternberg (HRS) cells showed EBER1 expression, LMP-1 staining positivity and EBNA-2 staining negativity, except for one case which showed LMP-1 staining negativity. Our histological findings indicate the percentage of CD8(+) , TIA-1(+) lymphocytes was significantly higher in HIV-HL than in non-HIV-HL cases (P < 0.05). On the other hand, the percentage of CD4(+) , FOXP3(+) lymphocytes was significantly lower in HIV-HL than in non-HIV-HL cases (P < 0.05) but present. The percentage of CCR5(+) lymphocytes was significantly lower in HIV-HL than in non-HIV-HL cases (P < 0.05). Usually, CD4(+) and CCR5(+) lymphocytes are reported to be rarely detected in HIV-associated non-Hodgkin lymphomas, but the presence of CD4(+) and/or FOXP3(+) lymphocytes may be implicated in the pathogenesis of HL. In addition, although additional CD8(+) lymphocytes are probably not EBV-LMP specific cytotoxic T-cells, these lymphocytes may also well be involved in the pathogenesis of HIV-HL.

A prognostic score for AIDS-related diffuse large B-cell lymphoma in Brazil.

The aim of this study was to evaluate a prognostic score for aids-related lymphoma (ARL). A retrospective study of 104 patients with ARL treated between January 1999 and December 2007 was conducted. Diffuse large B-cell lymphoma (DLBC) was the most observed histological type (79.8%). The median CD4 lymphocyte count at lymphoma diagnosis was 125 cells per microliter. Treatment response could be evaluated in 83 (79.8%) patients, and 38 (45.8%) reached complete remission (CR); overall response rate was 51.8% (95 CI = 38.5-65.1%). After a median follow-up of 48 months, the 4-year overall survival (OS) rate among all patients was 35.8%, with a median survival time of 9.7 months (95% CI = 5.5-13.9 months). The survival risk factors observed in multivariate analysis (previous AIDS and high-intermediate/high international prognostic index (IPI)) were combined to construct a risk score, which divided the whole patient population in three distinct groups as low, intermediate, and high risk. When this score was applied to DLBC patients, a clear distinction in response rates and in OS could be demonstrated. Median disease-free survival (DFS) for patients that achieved CR was not reached, and DFS in 4 years was 83.0%. Our results show that the reduced OS observed could be explained by poor immune status with advanced stage of disease seen in our population of HIV-positive patients. Further studies will be needed to clarify the role of different treatment approaches for ARL in the setting of marked immunosuppression and to identify a group of patients to whom intensive therapy could be performed with a curative intent.

[How far into the anal canal should the brush be introduced for more efficient cytological evaluation?]. / Quanto a escova deve ser introduzida no canal anal para avaliação citológica mais eficaz?

OBJECTIVE: In literature, sensitivity of Pap smears ranges widely from 45 to 98%. Possibly this is because there is no standard for how far the brush should be introduced into the anal canal. The aim was to evaluate whether the sampling site has an influence on the results of anal Pap smears. DESIGN AND SETTING: This is a non-randomized, non-blinded, retrospective review carried out in the Proctology and Pathology Sectors, Emilio Ribas Infectious Diseases Institute. METHOD: We obtained specimens with brushes introduced 4 cm into the anal canal in 114 patients (Group A) and 2 cm in 94 patients (Group B), before anorectal examination. These brushes were rotated five or six times before being withdrawn and rubbed on a slide that underwent Pap testing using standard cytopathology laboratory equipment. All patients were HIV-infected. Statistical tests were used. RESULTS: In Group A, 39 patients had anal canal condylomas and the cytology was positive in 29 of them (74.3%). We also observed cytological alterations in 30 of 75 patients (40%) without clinical lesions in the anal canal. In Group B, there were 54 patients with condylomas and 13 of them (24.1%) were confirmed by cytology. In 40 patients with no clinical lesions, we observed that nine (22.5%) had cytological abnormalities Statistical analysis revealed that examination in Group A was more efficient. CONCLUSION. Specimens collected by inserting the brush deeper into the anal canal improved the efficiency of anal Pap smears.

Hodgkin lymphoma among patients infected with HIV in post-HAART era.

BACKGROUND: Hodgkin lymphoma is considered a common type of non-AIDS defining tumor among patients infected with HIV, commonly presenting as a widespread disease and with different pathologic features compared with Hodgkin lymphoma in the general population. Despite that, the best treatment option is undefined. PATIENTS AND METHODS: The authors present a retrospective study of 31 patients with Hodgkin lymphoma-HIV attended at 3 Brazilian centers, 2 of them considered reference centers for HIV treatment. Chemotherapy schemes used were ABVD (doxorubicin/bleomycin/vinblastine/dacarbazine) or hybrid MOPP-ABV (mechlorethamine/vincristine/procarbazine/prednisone-doxorubicin/bleomycin/vinblastine), with prophylactic granulocyte colony-stimulating factor. RESULTS: Treatment response could be evaluated in 22 patients (70.9%) who completed initial treatment: 20 (91%) reached complete remission, 1 had partial remission, and 1 did not exhibit a response. The overall response rate was 95.5% (95% confidence interval, 91.2%-99.8%). After a median follow-up of 3 years, the overall survival (OS) rate among all patients was 80.3%; median OS was not reached. On univariate analysis, only CD4 cell count at diagnosis was significantly related to survival. CONCLUSION: This retrospective study shows that for patients with Hodgkin lymphoma development in the HIV setting in these 3 Brazilian centers, there was high complete remission and satisfactory OS rates, comparable with results found for Hodgkin lymphoma in patients without HIV.

P-glycoprotein expression in non-Hodgkin's lymphomas of human immunodeficiency virus infected patients.

Multidrug resistance (MDR) is a challenge in cancer treatment. One of the most studied mechanisms is P-glycoprotein (P-gp), which acts as a drug efflux pump, with decreased intracellular accumulation of drugs. It still needs to be clarified whether P-gp expression has a significant impact on non-Hodgkin's lymphoma treatment response, but a poor outcome has been reported in patients with positive P-gp expression. AIDS-related lymphomas have aggressive behavior, and although a complete response could be achieved, relapse is not uncommon. In an attempt to determine a possible relationship between MDR and poor outcome in this population, histologic samples obtained from 45 non-Hodgkin's lymphoma HIV-infected patients without previous cytotoxic therapy were submitted to immunohistochemical analysis using monoclonal antibody C494 specific for the MDR-1 isoform of P-gp. Samples from 27 patients (60%) were positive. Response to treatment (P=0.02) and overall survival (P=0.001) were significantly lower in patients with positive P-gp expression. In patients having achieved complete remission, the median disease-free survival (DFS) was not reached; the mean DFS was 57.2 months with DFS rates of 72.9% in three years. Our results show that P-gp is expressed before treatment of non-Hodgkin's lymphoma of HIV patients, and is related to poor response to treatment and overall survival.

[Anal cytology for screening of pre-neoplasic lesions]. / Citologia anal para rastreamento de lesões pré-neoplásicas.

BACKGROUND: High grade intra-epithelial neoplasias (HAIN) are probable precursors of anal carcinoma, with association to high-risk types of Human Papillomavirus (HPV). This progression could be related to severity of the dysplasia and, albeit not yet confirmed, treatment of these lesions would prevent the evolution to cancer. Standardization and improvement of screening methods should therefore be essential to treat or prevent precursor lesions, mainly in patients at risk such as seropositives to Human Immunodeficiency Virus (HIV). The aim of this study was to evaluate if anal cytology, with a cytobrush, could be useful to screen clinic and pre-clinic lesions provoked by HPV. METHODS: Brushes were used to obtain smears from the anal canal of 102 HIV-positive patients with proctologic complaints. There were 86 males and 16 females with a mean age of 37 years. HPV infection was denied by 33 patients, 14 had treated anal warts in the past, 28 had condylomas in the anal verge, seven had internal clinical lesions and 20 had both internal and external condylomas. The smears were submitted to Pappanicolaou and hematoxilin-eosin stains to identify cytological changes including HAIN. T CD4+ lymphocyte counts were also evaluated to check if the immunologic status caused more advanced dysplasia. RESULTS: One smear only proved insufficient. All the others revealed cellular patterns varying from normality to HAIN. Low grade AIN (LAIN) occurred in 30 and HAIN in 13 patients. One patient with HAIN, without a history of HPV infection in the past, presented an anal canal ulcer which at biopsy was diagnosed as invasive squamous-cell carcinoma. T CD4+ cells averaged 281/mm(3) for LAIN patients and 438/mm(3) for HAIN patients. Analyses disclosed a statistical difference, showing that despite expectations, more advanced dysplasias occurred in patients with higher counts of T CD4+ cells. This fact demonstrated that isolated systemic immunity did not seem to interfere in the genesis of these lesions, suggesting that aspects of local immunity should be studied. Statistical analyses by a 2x2 table revealed sensibility of 74% and specificity of 61%. CONCLUSION: Results suggest that cytology could be used to diagnose anal cancer precursors.

[Outcome of treatment of anal squamous cell carcinoma and its precursor in HIV-infected patients]. / Resultados do tratamento do carcinoma espinocelular anal e do seu precursor em doentes HIV-positivos.

OBJECTIVE: Incidence of anal squamous cell carcinoma is increasing mainly among HIV-positive patients. Treatment consists of radiotherapy and chemotherapy, sometimes followed by tumor resection. The objective was to evaluate the follow-up of such patients to verify recurrences and evolution from HAIN to cancer. This is a report of cases treated at the "Instituto de Infectologia Emílio Ribas", Sao Paulo, Brazil. METHODS: We attended 45 HIV-positive patients between July 1996 and June 2006. Most were male (97.7%), with ages ranging from 23 to 55 years (mean: 38.5 years). Thirty patients had high grade anal intra-epithelial neoplasia (HAIN), treated with local resection, and 15 with anal canal invasive squamous cell carcinoma were first submitted to chemo radiation, while biopsies were obtained during follow-up. RESULTS: Patients with HAIN had recurrences in 16.7% of cases and remained cancer free for up to five years. Chemoradiation was not possible in five patients with invasive carcinoma (40%) because three had advanced AIDS and two refused treatment. Eight (88.8%) out of nine patients had complete response to chemoradiation and remained cancer free for a period from three to six years. Chemoradiation failed in the ninth patient: abdominal perineal resection was performed, and there was no recurrence over a five-year period. CONCLUSION: We concluded that HAIN can recur after local resection in HIV-positive patients but does not evolve to invasive carcinoma. Invasive cancer can be treated in the same way as in HIV seronegative persons, when clinical conditions permit.

Non-Hodgkin's lymphoma among patients infected with human immunodeficiency virus: the experience of a single center in Brazil.

The relative risk of non-Hodgkin's lymphoma (NHL) among patients infected with human immunodeficiency virus (HIV) is elevated compared with the general population. We describe a retrospective study of 78 HIV-infected patients with NHL treated between 1999 and 2006 at the Infectology Institute, a reference center for HIV treatment in São Paulo, Brazil. All patients were treated with standard CHOP therapy (cyclophosphamide, doxorubicin, vincristine, and prednisone). An evaluation of treatment response was available for 48 (61.5%) of the patients who completed initial treatment. Twenty-three patients (47.9%) achieved a complete response (CR), 3 (6.3%) achieved a partial response, and 22 (45.8%) failed to respond to treatment. Of the 30 patients (38.5%) who were not available for response evaluation, 23 died of sepsis during treatment, 5 abandoned treatment, and 2 are still under treatment. After a median follow-up of 3 years, the overall survival rate for all patients is 20.5%. A univariate analysis showed a significant CR rate in patients with respect to the following factors: no acquired immunodeficiency syndrome (AIDS) diagnosis prior to the lymphoma, disease stage of I to II, and an International Prognostic Index (IPI) of low or low-intermediate risk. A multivariate analysis indicated that only a previous AIDS diagnosis and the IPI were significantly related to the CR rate. A median disease-free survival (DFS) time for the patients who achieved a CR was not reached, with a mean survival time of 73 months and a 3-year DFS rate of 77.5%. Our results provide additional information regarding HIV-related lymphoma in Brazil.

Bone marrow pathology in AIDS.

Bone marrow morphology is frequently abnormal in patients with AIDS. In this study, we reviewed 97 bone marrow biopsies of AIDS patients performed between 1998 and 2000 in the Emílio Ribas Institute of Infectology, which is the reference department for HIV. Specific diagnoses were performed in 33 cases. Fungi were observed in eight cases. Five of them were Histoplasma capsulatum, two were Cryptococcus neoformans, and one probably Candida albicans. Acid-fast bacilli were observed in 12 bone marrow biopsies, three of which were diagnosed to have no mycobacteriosis clinically. Foci of necrosis with clusters of macrophages without any well-formed granuloma were observed in nine cases and well-formed granuloma in three cases. Lymphomatous infiltration was observed in four cases of non-Hodgkin's lymphoma and in two Hodgkin's diseases (mixed cellularity). Extensive necrosis of bone marrow was observed in one case of Burkitt's lymphoma. In conclusion, bone marrow biopsy should be performed to elucidate the etiology of cytopenias, secondary infections, and fever of undetermined origin in AIDS patients.

Effects of long-term administration of Senna occidentalis seeds in the large bowel of rats.

Plants of the genus Senna that contain anthranoides derivatives are frequently used as cathartics. Radiological studies have demonstrated that patients with chronic constipation who have used stimulant laxative have colonic redundancy and dilatation more frequently than patients who have not. The objective of the present work was to study morphological and histochemical changes of the lower gut after administration of Senna occidentalis seeds for a long period to rats, as observed in skeletal muscle fibers. Fragments of the lower gut of young and adult rats treated with S. occidentalis seeds (2% for 171 days and 3% for 61 days in the diet) were submitted to histological and histochemical analysis and to densitometry. The most important finding was decreased oxidative enzyme activity in smooth muscle cells and in myenteric neurons of the large bowel. As oxidative metabolism is essential for ATP and energy production, these results suggest that the functional intestinal disturbance caused by the chronic use of Senna occidentalis as a laxative can be due to a metabolic effect involving energy production, which would decrease colonic motility and cause functional colonic dilatation, but without any irreversible anatomic change.

Herpes simplex type 2 pneumonia.

Extensive reviews of pulmonary infections in AIDS have reported few herpetic infections. Generally these infections are due to Herpes simplex type 1. Pneumonia due to herpes type 2 is extremely rare. We describe a 40 year-old HIV positive woman who complained of fever, cough and dyspnea for seven years. She had signs of heart failure and the appearance of her genital vesicles was highly suggestive of genital herpes. Echocardiography showed marked pulmonary hypertension, right ventricular hypertrophy and tricuspid insufficiency. After a few days of hospitalization she was treated with Aciclovir and later with Ganciclovir. An open pulmonary biopsy revealed an interstitial inflammation, localized in the alveolar walls. Some pulmonary arteries had widened walls and focal hyaline degeneration. Immunohistochemistry indicated that the nuclei had herpes simplex virus type 2 in many endothelial cells (including vessels with widened walls), macrophages in the alveolar septa and pneumocytes. There was clinical improvement after treatment for herpes. We concluded that as a consequence of herpes infection, endothelial involvement and interstitial inflammation supervene, with thickening of vascular walls and partial obliteration of the vessel lumen. A direct consequence of these changes in pulmonary vasculature was pulmonary hypertension followed by heart failure.

Dejerine-Sottas disease: a case report.

CONTEXT: Hereditary peripheral neuropathies (hereditary motor-sensory neuropathies or hereditary demyelinating neuropathies) are abnormalities of Schwann cells and their myelin sheaths, with peripheral nerve dysfunction. They include Charcot-Marie-Tooth disease, Dejerine-Sottas disease, congenital hypomyelinating neuropathy and hereditary neuropathy with liability to pressure palsy. OBJECTIVE: The objective of the present work was to describe a case of Dejerine-Sottas disease. CASE REPORT: A 9-year-old boy presented progressive slight motor deficit in the lower limbs, particularly in the feet, and generalized hyporeflexia. Electromyography disclosed significant reduction in motor and sensory nerve conduction velocities. Sural nerve biopsy showed axons surrounded by a thin myelin sheath and concentrically arranged cytoplasmic processes of Schwann cells forming onion-bulbs. No axon damage was observed.

[Human papillomavirus oncogenicity and grade of anal intraepithelial neoplasia in HIV positive patients]. / Oncogenicidade do papilomavírus humano e o grau de neoplasia intra-epitelial anal em doentes HIV positivo.

OBJECTIVE: We decided to evaluate if grade of anal intraepithelial neoplasia (AIN) was associated to the HPV type in HIV positive patients, since this group of patients has immunodeficiency over long periods. We identified HPV types by PCR (polimerase chain reaction) and histological examination to determine the AIN grade in 39 HIV positive males with anal condylomata acuminata. RESULTS: We observed high grade AIN (HAIN) in 9 (23.1 percent) and low grade AIN (LAIN) in 30 patients (76.9 percent). The most frequent HPV types were 6 and 11 (64 percent) and oncogenic types 16, 18 and 31 appeared in 20.5 percent of patients. We could not identify viral type in four patients (10.2 percent) despite tests revealing presence of viral deoxiribonucleic acid. Comparing AIN grades with viral types we observed that non-oncogenic types can also be associated with HAIN lesions. CONCLUSION: These results allowed us to conclude that both oncogenic and non-oncogenic HPV types can be associated with HAIN lesions in HIV positive patients.

Local control of human papillomavirus infection after anal condylomata acuminata eradication.

OBJECTIVE: To verify whether the eradication of anal condylomata acuminata was effective for local control of HPV infection using anal colposcopy and anal brush cytology. METHODS: We evaluated 147 patients treated for anal margin and/or anal canal condyloma, with 108 HIV-positive and 39 HIV-negative individuals. The average age for males was 40 years for HIV-positive and 27.5 for HIV-negative. In females, the mean age was 37.5 years for HIV-positive and 31.5 for HIV-negative. RESULTS: Twenty-four patients (16.3%) had normal cytology and anal colposcopy, 16 (10.9%) normal cytology and altered anal colposcopy, 52 (35.4%) normal anal colposcopy and altered cytology, and 55 (37.4%) had altered cytology and anal colposcopy. CONCLUSION: the eradication of clinical lesions failed to locally control HPV infection.

Epstein-Barr Viral Load is Associated to Response in AIDS-Related Lymphomas.

AIDS-related lymphoma (ARL) development is associated to immunodeficiency state with proliferation of B-cells driven by HIV itself and EBV infection. However, Epstein-Barr DNA is not detected in malignant cells of all ARL subtypes. A prospective and controlled study to analyze EBV viral load (VL) in plasma and peripheral blood mononuclear cells (PBMC) of ARL patients was performed to analyze if Epstein-Barr VL could be related to response in these patients. Fifteen patients with ARL were included in this study with measurement of EBV VL at three different periods of time: at lymphoma diagnosis, upon completion of chemotherapy, and 3 months after. Two control groups composed by HIV-negative and HIV-positive patients were also evaluated for EBV VL comparison. In situ hybridization for EBER was performed on diagnostic samples of all ARL patients. Median EBV VL in PBMC and plasma had a significant decrease (p = 0.022 and p = 0.003, respectively) after ARL treatment. EBER was positive in 7 (46.7 %) cases. Median EBV VL in PBMC before lymphoma treatment in patients positive for EBER was significantly higher compared to EBER negative cases (p = 0.041). Reduction of EBV viral load during treatment of lymphoma could be predictive of response. EBER expression was associated to advanced stages of disease and worse immune status. Our study suggests that measurement of EBV VL during ARL treatment could be used as a marker for response, but further studies are needed to validate this association.

Evaluation of Langerhans cells counts comparing HIV-positive and negative anal squamous cell-carcinoma patients.

PURPOSE: To investigate the differences in Langerhans cells (LCs) populations between HIV-positive and negative anal squamous cell carcinomas patients. METHODS: Twenty five patients (14 HIV-positive and 11 HIV-negative) were evaluated. Paraffin-block transversal thin sections from biopsies of anal squamous cell carcinomas (ASCC) were stained using the anti-CD1A antibody that identifies activated LCs. LCs counts were performed using histometry at 20 different sites, at baseline in the ASCC cases. These were then compared with LCs counts in anal canal specimens from HIV-negative and positive patients without ASCC (controls groups). RESULTS: In patients with ASCC, the LC count was greater among HIV-negative individuals than among HIV-positive individuals (p<0.05). The LC count was greater in the control HIV-negative group than in HIV-positive patients with ASCC (p<0.05). CONCLUSION: There was a lower amount of activated LCs in HIV-positive patients with anal squamous cell carcinomas than in HIV-negative patients, thereby suggesting worsening of the immune response.

Local control of human papillomavirus infection after anal condylomata acuminata eradication / Controle local da infecção perianal pelo papilomavirus humano após a erradicação dos condilomas acuminados

OBJECTIVE: To verify whether the eradication of anal condylomata acuminata was effective for local control of HPV infection using anal colposcopy and anal brush cytology. METHODS: We evaluated 147 patients treated for anal margin and/or anal canal condyloma, with 108 HIV-positive and 39 HIV-negative individuals. The average age for males was 40 years for HIV-positive and 27.5 for HIV-negative. In females, the mean age was 37.5 years for HIV-positive and 31.5 for HIV-negative. RESULTS: Twenty-four patients (16.3%) had normal cytology and anal colposcopy, 16 (10.9%) normal cytology and altered anal colposcopy, 52 (35.4%) normal anal colposcopy and altered cytology, and 55 (37.4%) had altered cytology and anal colposcopy. CONCLUSION: the eradication of clinical lesions failed to locally control HPV infection. .

OBJETIVO: verificar se a erradicação dos condilomas acuminados perianais foi efetiva no controle local da infecção pelo HPV, utilizando a colposcopia anal e a citologia anal com escova. MÉTODOS: avaliamos 147 pacientes tratados de condiloma da margem e/ou canal anal, sendo 108 HIV-positivos e 39 HIV-negativos. A média etária no sexo masculino foi 40 anos para os HIV-positivos e 27,5 anos para os HIV-negativos. No sexo feminino, a média etária foi 37,5 anos para os HIV positivos e 31,5 anos HIV-negativos. RESULTADOS: vinte e quatro pacientes (16,3%) apresentavam citologia e colposcopia normais, 16 (10,9%) citologia normal e colposcopia alterada, 52 (35,4%) citologia alterada e colposcopia normal e 55 (37,4%) citologia e colposcopia alteradas. CONCLUSÃO: a erradicação das lesões clínicas não controlou localmente a infecção pelo HPV. .

Frequência de alterações citológicas anais em pacientes com citologia cervical normal / Frequency of anal cytological abnormalities in patients with normal cervical cytology

Contexto e objetivo: O câncer anal corresponde a 4% de todas as neoplasias malignas do trato digestivo baixo.A incidência deste tipo de câncer e de suas respectivas lesões precursoras aumentou nos Estados Unidos, Europa eBrasil. A lesão intraepitelial escamosa anal de alto grau (LIEAG anal) é considerada provável precursora do tumor analinvasivo. Há alguma evidência de ligação entre o câncer anal e o câncer genital. O objetivo do presente estudo foiestimar a prevalência de alterações citológicas da mucosa anal em mulheres com citologia cervical positiva.Tipo de estudo e local: Corte transversal, realizado no Instituto de Infectologia Emílio Ribas.Métodos: Foram colhidas amostras para citologia cervical e anal de 104 mulheres (todas com lesões intraepiteliaisde baixo ou alto graus). Em um período de até um mês do resultado da primeira coleta citológica, foi realizada novacoleta cervical e duas amostras de esfregaço do canal anal. Todas as amostras foram obtidas com escova de coletacitológica cytobrush. As pacientes foram questionadas quanto à prática de intercurso anal. Os esfregaços citológicosforam classificados segundo a classificação de Bethesda 2001.Resultados: Das 104 pacientes com citologia cervical anormal, 51 (49%) apresentaram LIEAG cervical, 48 (46,2%)LIEBG cervical, 5 (4,8%) atipia escamosa de significado indeterminado (ASC-US) cervical. Destas 104 pacientes, 75(72%) também apresentaram citologia anal anormal e 29 (28%) esfregaços anais normais ou inflamatórios. Não houvediferença estatística entre os grupos com HSIL e LSIL cervicais, no que tange à propensão a apresentar citologia analanormal (P > 0,05). Não houve diferença estatística significante entre os grupos quanto à propensão da presença dealterações citológicas anormais anais nas pacientes que praticavam intercurso anal (P > 0,05).Discussão: Nossos resultados sugerem que a transmissão do vírus HPV da mucosa anal para cervical ou vice-versa sejadecorrente de questões anatômicas, como proximidade do orifício anal e hábitos de higiene pessoal, e não de relaçõessexuais anais.Conclusão: Houve prevalência de 72% de citologia anal anormal nas pacientes com citologia cervical positiva, porém,é necessária realização de mais estudos para se estabelecer se a mucosa anal é realmente um reservatório para oHPV, o que por si só já é epidemiologicamente importante para futuros programas de erradicação de lesões cervicaisrelacionadas ao HPV.

Bone marrow biopsy in the diagnoses of infectious and non-infectious causes in patients with advanced HIV infection.

AIMS: Fever and peripheral blood abnormalities in patients with advanced acquired immunodeficiency syndrome are usually due to disseminated opportunistic infections. The objective of this study was to evaluate the diagnostic yield of histopathological and microbiological investigations of bone marrow samples from HIV-infected patients with fever and/or cytopenias. METHODS AND RESULTS: The diagnostic utility of bone marrow aspiration, biopsy and culture was retrospectively examined in 82 patients with HIV/AIDS (median CD4 count 51 microL(-1), range 1-430 microL(-1)) with peripheral cytopenias and/or fever attended at a large tertiary care hospital in Brazil during a one-year period. The diagnostic yield of bone marrow biopsy was 34.1% (28 cases) in contrast to only 8.5% (eight cases) attained by the bone marrow smear. Opportunistic pathogens were isolated from bone marrow cultures in 26.8% of patients. CONCLUSIONS: Bone marrow biopsy has value in diagnosis of opportunistic infections, malignancies or other conditions in one-third of adult patients with advanced AIDS and fever or cytopenias and should be considered in this patient group.